When English becomes a barrier to care

Demand for medical interpreters booming as demographics shift

SAN FRANCISCO (MarketWatch) -- Gayle Tang remembers the time she thought she was speaking English but only realized she had lapsed into Cantonese when one of her doctors spoke it back to her.

That was 14 years ago, but she recalls the uneasy feeling of not knowing what was wrong with her and undergoing tests for heart palpitations. The doctor's words in the language she needed to hear and speak at that sensitive time moved her, she said.

"It was very natural, very comforting," Tang said. "I was able to express myself and it was emotional. I felt, wow this person really cared about me."

The experience gave Tang insight into what patients who speak languages other than English may face when they're frightened and in the throes of medical treatment.

"It's very exhausting to try to communicate your most personal information in a language you may not be as comfortable in when you're under stress," said Tang, director of national linguistic & cultural programs for Kaiser Permanente in Oakland.

"When people are under duress, they may lose their language skills," she said. "It's not like going to the bank and making a banking transaction or going to the grocery store and buying food."

Kaiser Permanente has been on the forefront of a movement toward greater linguistic and cultural competence in health care. Kaiser routinely asks patients which language they prefer to speak, and developed a voluntary physician assessment tool that lets health-care organizations determine if doctors have enough foreign-language proficiency to speak with patients in that language independent of an interpreter. About 1,000 doctors have taken the test so far.

As the nation's population grows and ages, the demand for language services in hospitals, doctor's offices and other health-care arenas is booming, experts say.

Federal law mandates that any entity that receives federal funding, whether it's Medicare reimbursement or research grants, must provide a patient with limited English proficiency an interpreter at no cost to the patient. In early 2009, California enacted a language-services law requiring all health plans and insurers to provide an interpreter for limited-English speaking patients at no cost to the patients.

The House of Representatives' health-reform bill calls for a study into how the Medicare program makes use of language services for beneficiaries who have limited English proficiency. If a health-care overhaul expands coverage as promised, an influx of newly insured people into the Medicaid program also may increase demand for medical interpreters. Health-care reform: See our complete coverage.

An estimated 15,000 to 17,000 people perform medical interpreting work in the U.S., according to Common Sense Advisory, a Boston-based research firm. Interpreters typically earn $15 to $30 an hour.

Driven to standardize

As hospitals look to boost patient safety and limit their exposure to potential lawsuits if a crucial detail gets lost in translation during a fast-paced medical response, some are open to a new national certification standard for the people they hire to provide medical interpretation.

In October, a nonprofit group launched a first-of-its-kind national interpreting standard that will allow interpreters working in the medical field to be tested and credentialed as certified medical interpreters, or CMIs. The CMI designation first will be available to Spanish language interpreters, with national certification for several other languages starting next year.

At M.D. Anderson Cancer Center in Houston, interpreters have to have at least one year of experience doing medical interpretation. They then go through three months of in-house training including medical and oncological terminology and technical aspects of interpretation, said Cesar Palacio, manager of the language assistance department.

"Right now when we hire someone we have to take a very good look at their credentials and verify that they really know what they're doing," he said. "If we have national or state certification, at least we'll have a benchmark for establishing credentials."

The field of medical interpretation has come a long way from when patients would rely solely on their minor children or when hospital staff would comb their ranks for candidates or ask if anyone in the waiting room spoke Polish, for example, said Dr. Eric Hardt, medical consultant to interpreter services at Boston Medical Center.

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